We assessed the prevalence and associations of symptoms of insomnia in patients with acute ischemic stroke, and evaluated whether mianserin as a sedative antidepressant is beneficial in the treatment of poststroke insomnia. One hundred consecutively hospitalized patients were randomized to receive 60 mg/day of mianserin (n = 51) or placebo for 1 year in a double-blind trial with a 6-month follow-up after the therapy. Symptoms of insomnia were assessed with the three insomnia-related items of the Hamilton Depression Scale; patients were defined as insomniacs if any of these items was positive. Complaints of insomnia occurred in 68% of patients on admission, and in 49% at 18 months, and they were as frequent in all subgroups of patients. From 2 months, symptoms of insomnia were associated independently with depression. Living alone before stroke (at 0 and 2 months) and age (at 12 months) were other independent predictors of insomnia. The rate of recovery as evaluated by the insomnia score was more rapid in patients on mianserin than in those on placebo. At 2 months, the scores were significantly different favoring mianserin treatment (1.3 vs. 0.8, p = 0.02). We conclude that insomnia is a common complaint after ischemic stroke. Mianserin had a beneficial influence on the recovery from symptoms of insomnia, even though the intensity of poststroke depression was low.

Palomäki H, Partinen M: Sleep and stroke; in Culebras A (ed): Sleep Disorders and Neurological Disease. New York, Dekker, 2000, pp 289–302.
Harris Y, Gorelick PB, Cohen D, Dollear W, Forman H, Freels S: Psychiatric symptoms in dementia associated with stroke: A case-control analysis among predominantly African-American patients. J Natl Med Assoc 1994;86:697–702.
Kucukdeveci AA, Tennant A, Hardo P, Chamberlain MA: Sleep problems in stroke patients: Relationship with shoulder pain. Clin Rehabil 1996;10:166–172.
Vestergaard K, Mohr Drewes A, Andersen G, Jorgensen T: Post-stroke sleep disorder treated with the selective serotonin reuptake inhibitor citalopram – a case study. Eur J Neurol 1996;3:164–168.
Hamilton M: Rating scale for depression. J Neurol Neurosurg Psychiatry 1960;2:56–62.
Beck AT, Steer RA, Garbin MG: Psychometric properties of the Beck Depression Inventory: Twenty years of evaluation. Clin Psychol Rev 1988;8:77–100.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, ed 3, revised (DSM-III-R). Washington, American Psychiatric Association, 1987.
Andersen G, Vestergaard K, Riis JO, Lauritzen L: Incidence of post-stroke depression during the first year in a large unselected stroke population determined using a valid standardized rating scale. Acta Psychiatr Scand 1994;90:190–195.
Palomäki H, Kaste M, Berg A, Lönnqvist R, Lönnqvist J, Lehtihalmes M, Hares J: Prevention of poststroke depression: 1 year randomised placebo controlled double-blind trial of mianserin with 6-month follow-up after therapy. J Neurol Neurosurg Psychiatry 1999;66:490–494.
Feigher JP, Jacobs RS, Jackson RE, Hendrickson G, Merideth CH, O’Meara PD: A double-blind comparative trial with mianserin and amitriptyline in outpatients with major depressive disorders. Br J Clin Pharmacol 1983;15:227S–237S.
Khan MC, Bennie EH, Stulemeijer SM, Ravens MA: Mianserin and doxepin in the treatment of outpatient depression with anxiety. Br J Clin Pharmacol 1983;15(suppl 2):213S–218S.
Pinder RM: Mianserin: Pharmacological and clinical correlates. Nord Psykiatr Tidsskr 1991;45(suppl 24):13–26.
Ohberg A, Vuori E, Klaukka T, Lönnqvist J: Antidepressants and suicide mortality. J Affect Disord 1998;50:225–233.
Idänpää-Heikkilä J: Mianserin and blood dyscrasias in Finland. Organon Tiedote 1988;19:25–27.
Coulter DM, Edwards IR: Mianserin and agranulocytosis in New Zealand. Lancet 1990;336:785–787.
Mahoney FI, Barthel DW: Functional evaluation: The Barthel Index. Md State Med J 1965;14:61–65.
Viitanen M, Fugl-Meyer KS, Bernspång B, Fugl-Meyer AR: Life satisfaction in long-term survivors after stroke. Scand J Rehabil Med 1988;20:17–24.
Kaste M, Palomäki H, Sarna S: Where and how should elderly stroke patients be treated? A randomized study. Stroke 1995;26:249–253.
Kaitaro T, Koskinen S, Kaipio M-L: Neuropsychological problems in everyday life: A 5-year follow-up study of young severely closed-head-injured patients. Brain Inj 1995;7:713–727.
Kertesz A: The Western Aphasia Battery. New York, Grune & Stratton, 1982.
Scandinavian Stroke Study Group: Multicenter trial of hemodilution in ischemic stroke: Background and study protocol. Stroke 1985;16:885–890.
Ellfolk M, Heikkilä R, Huotari K, Koskela J, Pelkonen R (eds): Laboratory Handbook 96–97, United Laboratories Ltd (in Finnish). Keuruu, Otava Publishing, 1996.
Kotila M, Numminen H, Waltimo O, Kaste M: Depression after stroke. Results of the FINNSTROKE study. Stroke 1998;29:368–372.
Thorpy MJ, Diagnostic Classification Steering Committee: International Classification of Sleep Disorders: Diagnostic and Coding Manual, Revised. Rochester, American Sleep Disorders Association, 1997.
National Heart, Lung, and Blood Institute Working Group on Insomnia: Insomnia: Assessment and management in primary care. Am Fam Physician 1999;59:3029–3038.
Partinen M, Kaprio J, Koskenvuo M, Langinvainio H: Sleeping habits, sleep quality, and use of sleeping pills: A population study of 31,140 adults in Finland; in Guilleminault C, Lugaresi E (eds): Sleep/Wake Disorders: Natural History, Epidemiology, and Long-Term Evolution. New York, Raven, 1983, pp 29–36.
Ford DE, Kamerow DB: Epidemiological study of sleep disturbances and psychiatric disorders: An opportunity for prevention. JAMA 1989;262:1479–1484.
Weyerer S, Dilling H: Prevalence and treatment of insomnia in the community: Results from the Upper Bavarian Field Study. Sleep 1991;14:392–398.
Gislason T, Almqvist M: Somatic diseases and sleep complaints. An epidemiological study of 3,201 Swedish men. Acta Med Scand 1987;221:475–481.
Hyyppä MT, Kronholm E: Quality of sleep and chronic illnesses. J Clin Epidemiol 1989;42:633–638.
Fruhwald S, Loffler H, Baumhackl U: Depression after cerebrovascular injury. Review and rehabilitation from other psychiatric complications. Forschr Neurol Psychiatr 1999;67:155–162.
Bassetti C, Chervin R: Cerebrovascular diseases; in Kryger MH, Roth T, Dement WC (eds): Principles and Practice of Sleep Medicine. Philadelphia, Saunders, 2000, pp 1072–1086.
World Health Organization: Rational Use of Benzodiazepines. Geneva, World Health Organization, 1996.
Goldstein LB: Common drugs may influence motor recovery after stroke. The Sygen In Acute Stroke Study Investigators. Neurology 1995;45:865–871.
Mendelson WB: Human Sleep: Research and Clinical Care. New York, Plenum Press, 1987.
Otani K, Sas H, Kaneko S, Kondo T, Fukushima Y: Steady-state plasma concentrations of mianserin and its major active metabolite desmethylmianserine. Ther Drug Monit 1993;15:113–117.
Smith AHW, Naylor GJ: The antidepressant properties of mianserin and its effect on sleep. Acta Psychiatr Belg 1978;78:813–826.
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